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Home My WebLink AboutPermit Building 1981-9-1 t I I.. \, ~/ I INSPECTION L1IIE 726-3769 Job Address \D0\ 0 \\~~~~). Legal Description '1-03-1) 1, ..- r _ _ II" / I Owner ~ \C' ~C'\. (' r\ ~t~\:\\E> (' Address \\)~\ () ~ 'y\ \'\\\H ~ . constr~S~~~ ~~O~~ Address Ut> HiN TlAf~ Primary Struc.tural , Electrical f1echani ca 1 CONTRACTORS 4IIt CITY Uf SPRINGFIELO COMBHIATION APPLICATION/PERMIT EIIERGY SOURCES: Heat 1,later Heater Range~ Valu€ of Hark: , INFORlIATION L1Nl 726-3753 Sq. Ftg. 1.lain ~q. Ftg. Access. Sq. Ftg. Other Ilew Add Alter Pep. ~Deiiio_Change/Use . ~' Phone . BuildinQ Permit Info: Oeser be Work{i.e., Build Single ~') Familv nesidence With Attached Garaael ,I" \. .\. o...f\o.' 0......> ~ J\ . \ \:\ 'i::'lf\'C\L_' -~'C\. I t\ - \. Il "0 ~ -(? .'\)- nics. no.l" (exoires) ~~.I'\l\P.l (name) Phone (address 1 (ohane no.\ (name} (address) flies. no.) (exoires) (bhone no. Genera 1 Plumbin~."'\\Cl ~, ElectriC:ill Heehani ca 1 . --==-=~= 0..=-_;0. _ OO-N(f~-"-'- Each single fixture ~.~ - _~ .-_ ."..."., _~_., ._~=.==.,....;;r....." - MECHANICA~' j ---,-1 furnace/burn:: :o~; 'FFr- .~1. BTU's , I I PLUIIBIIIG -~ .~ erF =1.i:iJARJiIA SQ. FT. ELECTRICAL FFF-rH{Qr;F~ ~n- --.,..-,,- =--- Residence of Relocated building (new fix. additional) New circuits alts. or extensions Floor furnace and vent S.F. Residence (1 bath) Duplex (1 bath) each I IOf amps.[ I ICOMfl./INO. FEEDERS [ I IInstall/alter/relocate I rl;~t~;h_ f~~rlp~~ \ \ a ("<'l ;}oJ I I Of amp~1 \. - L ffi I -l....M t'1l:A..-J I =~~k'\~~' Iff~~~ J\N\Q\ I . I \.~f\ fl\l' U I \D~ TOTAL CHARGES \ ~CO I TOTAL CHARGES \F'\. (X) TOTAL CHARGES WHERE STATE L.\\/ REQUIR~S that the Electrical work be done by an Electrical Contractor, the electrical portion of this permit shall not be vali1 until the label has been signed by an Elec:trical Supervisor and returned to the Building Oivision I HAVE CAREFULLY EXNIINED the completed application for permit, and do hereby certify that all information hereon is true and correct. and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein, and that NO OCCUPAr~CY win be made of any structure without the permission of the Building Division. I further certify that my registration with the 'Builder's Board is in full force and effect as required by ORS 701.055. that if exempt the basis for exemption is noted hereon. and that only subcontractors an~employees who are in comoliance with OP.S 7nl.055 will be used on this Rroject. , , (pi' /; t~,...J IW.IE(please print) R ,C'}.,4,e.,./ ~ . STOTlk/e... SIGIIATURE A0___j:t~u_/'(~----?:r~ DATE~ .\ Fon OfF I CE USE DlK Y Sq. Ftg. "ain Sq. Ftg. Access Sq. Ftg. Other Additional bath Water service Sewer Storm Sewer Zone Fi re Zone Flood Plain BUILDING PERfllT Charges anc Surcharges PLUI1BING PERMIT Charges and Surcha rges .' ELECTRICAL PERI:IT Charges and Surcharges MECHANICAL PERMIT Charges and \~ Surcharges SERVICES Recessed wall -'! ~n~rp "p~tpr ~nrl vpntl , Temporary Construction I'change in existing rp~ j QPPC:P [multifamily. comm. or lnduo;trial Appliance vent ~@oar;ttp Stationary evap. cnnler Vent fan wi th sinal@ dlJct. , Vent sys ter.l apa rt heatino or A.C. Mechanical exhaust hood and duct from Wood stove/heater ISSUANCf OF PFRIHT ~l Type/Canst. Bedrooms Units Oc:cy Load Occy Group x Value Value Value > Stories > TOTAL VALUATION . Plan Ck. COIIIII/lnd ____________....2..2!/Blda PJ'r Fpp Plan Ck. Res 30%/Blda Per Fee \~ lX:) Fence -- - :1;-0- Demo __\f\,C() I Sidewalk -. ~ (~A/C Paving I Curb Cut ------------ I Systems Development Charae (I.S~) ITotal Comb. rermit I I TOTAL aw.~ ., t . (-\~ . . COMBINATION APPLICATION/PERMIT (CAP) PERMIT VALIDATION I. Applic:ant to furnish A. Job Address B. Legal Description 1. example- Tax Lot 100, Lane County Map Reference 11 oj 43 2. example- Lot 1. Block 3, 2nd Addition to Springfield Estates C. Name. etc. of owner and construction lender D. Energy Sources 1. examele- heat/electrical ceilinq/or forced air Qas 2. exa~le~ waterheater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examele- 1250 sq. foot house, 500 sq. foot garage 2. examole- if new project, check new - if addition, check add. etc. F. Building permit information: 1. examele - construct single family house with an attached garage 2. examole - remodel existing garage into family room 3. examole - convert single family residence into restaurant (change of use) G. Value of work as defined in Section 303 (a) of the Structural Specialty Code H. DESIGN TEAM AND CONTRACTORS To avoid design or construction delays, Building Division Staff must be able to contact appropriate persons regarding design information or job site corrections. etc. II. Abbreviated Plumbing, Mechanical, & Electrical Schedules A. Except where blank spaces occur in the description portion of the Mechanical and Electrical Schedules, the applicant need fill-in only the No. Boxes adjacent to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedules are available at the Building Division I. To conserve space on the permit form the schedules have been abbreviated 2. If the item(s) to be installed are not covered on the abbreviated schedules you should consult the full schedules C. BUILDING DIVISION STAFF WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must be delivered to the electrical contractor for signature by his electrical supervisor. The general contractor is .not authorized to sign the electrical label. --- Ill. Applicant to sign and date Whenever possible. the initial application will be used as a worksheet only. Where possible, Building Division Staff will prepare a type written copy and return it to the applicant at the time the actual permit is issued for his signature. IV. Fees and Charges Plan chec:k fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY Permit Clerk ~ PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: .' Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date , , , j . , ltISPECTIOl1 LIIIE ] 726-3769 . - CITY UF SPRINGFIELU COIIBIiIATION APPLICATION/PERMIT E!IERGY SOURCES: Heat !'/ater Heater . INFORlIATION urll I 726-3753 Sa. Ftq. 1.lain ~q. ~tg. Access. SQ. Ftq. Other -1lew~Add_Al ter _JeD. ") ~Oemo Change/Use. ~ I~I - p Describe Work(i.e., Build Single I Attached Garaoe) Job Address \D~\ 0 \\~'\'{\\ \ ~ ~ legal Oe~cription ".'\. . Owner ~ \(' "l"\\ r\. ~('\-\\\~ (' Address \\)~\ ('\ \\~(" \'\C\~~. 8:-. ~C\c\..~ ~'CO Construction l~der Address DESIGII TENI Primary Structural , Electrical t1echanical CONTRACTORS RanQe_ ValuE of Hark: Phone Builriina Permit Info: Familv Residence Hith ~\'n-I'\LlP-1 , '- ~ QJ;)Ci ~ ~~~" '" \' \ \\ <;:'\~'C\? (~ ~A j\ Il"0 q {) r\). (lies_ no.)' (exoires) (~honp. nn (name) Phone (address) i I I I ., I {name) (addrpss 1 (lie,," nn,) (plfnil"pc:.l (nhnnp nn Genera 1 Plumbin~.'""'\I\c) i'-...... Electrical . .!J!sM!!.!s.~.J.~- ."._.~ _ --1!Q." _.,;-".~""".:--_..",-"",,- ...-, . ../ .. ."~"..lli'. . MECHAN I CAL PLUIIBIIIG ELECTRICAL FFF......-.rHrrRr.-~- "'.;n-~~.---_.- - :. (rr I 1 I I Recessed wall ~nace h~atp.r a"~ I 1 Appliance vent , s.eo1ratp. I Stationary evap. cooler I Vent fan wi th sinole dl1r:t Residence of furnace/burner to BTU's Each single fixture SQ. FT. IRelocated building (new fix. additional) 1 S.F. Residence 11 bath \ louPlex (1 bath) each IAdditional bath I I I I 1 I I I \ J.. 0 ('\l ; J.-...; I J-t;r L \If\'f\()/ _I \\:\D..""",,"O I . - \ f Water service Sewer IStorm Sewer I INew circuits alts. or extensions I SERVICES -I Floor furnace and vent Temporary Construction Change in existing rpc; i.4rnce Imultifamily~ comm. or Tnrlllc:::tri~l IOf ICO~1./INO. FEEDERS I Install/alter/reloc:ate rlictr;~ f~~rl~rc IOf amp'-I amps, I HAVE CAREFULLY EXAIIINEO the completed application for permit, and do hereby certify that all information hereon is true and correct. and I further certify that any and all work cerformed shall be done in accordance with the Ordinances of the City of Soringfield and the laws of the State of Oregon pertaining to the work described herein. and that UO OCCUPA'~CY will be made of any structure without the permission of the Building Division. I further certify that my registration with the'Builder1s Board is in full force and effect as required by ons 701.055, that if exempt the basis for exemption is noted hereon. and that only subcontractors an~em~loyees who are in comoliance with OP.S 701.055 will be used Qn this project. , , . / IWIE(please print) 1?f('k~Vr/ /... 577'77(-rP_. SIr.IIATURJt:/L_ <-'fi(/::>/'J{~ nATF~rt.\ ~I FOn OFFICE USE DilLY Zon-e Tvoe/Const. Units Sq. Ftg. fiain )t Value Fire Zone Bedrooms Occy load Sq. Ftc]. Access x Value Flood Plain Stories Occy Group Sq. Ftg. Other )t Value TOTAL VALUATION BUILOWG PERfIIT Charges an~ Surcharges PLU'~BING PERMIT Charges and Surcharges . ELECTRICAL PERI:IT Cha rges and Surcharges I'ECHANICAL PERMIT Charges and SUrcharges Plan Ck. Comm/lnd 65%/Rldo Ppr Fpp ------------P'Tdn Ck. Res 30%'Blda Per Fee \~ 00 Fence -- - :10-0-1 Demo __\F\.CO I Sidewalk -, ~ n A/C Paving I Curb Cut ------------ I Systems Development Charae (I.S~) ITotal Comb. rermi t I I iOTAL dLo.CQ.' . COMBINATION APPLICATION/PERMIT (CAP) I. Applicant to furnish A. Job !.ddress B. Legal Description 1. example. Tax Lot 100. lane County Map Refere f II 03 43 ' 2_ ~xam)'le- Lot I. Block 3, 2nd Addition to ~prlngtield Estates C. Name, etc. of owner and construction lender O. Energy Sources 1. examole- heat/electrical ceilinq/or forced a 2. examole- waterneater/electrlcal/or solar E. Square footage or valuation, etc. ------ 1. examole- 1250 sq. foot house, 500 sq. foot g' 2. example- if new project. check-new - if addit cneck add. etc. F. Building permit information: 1. example - construct single family house with attached garage 2. exam~le - remodel existing garage into family 3. examole - convert single family residence int restaurant (Change of use) G. Value of work as defined in Section 303 (aJ of th Structural Specialty Code H. DESIGN TEAr-! ANO CONTRACTORS ( To avoid design or construction delays, Building Division Staff must be able to contact appropriat, persons regarding design information or jOb site corrections, etc. ( II. Abbreviated Plumbing, Mec:hanical, & Electrical Schedu. . A. Except where blank spaces occur in the descriptiol portion of the Mechanical and Electrical Schedule, the appl ic:ant need fill-in only the No. Boxes adj, It:. to the appropriate item(s) to be installed B. Full Plumbing, Mechanical, and Electrical Schedule are available at the Building Division 1. To conserve space on the permit form the sched t have been abbreviated ' 2. If the item(s) to be installed are not covered the abbreviated schedules you should consult t fu 11 schedu 1 es C. BUILOIllG DIVISION STAFF WILL FILL OUT ALL FEES AND '. CHARGES ON THE SCHEDULES O. As noted on the CAP, the label must be delivered t electrical contractor for signature by his electri, supervisor. The general contractor is .not authori: ( to sign the electrical label. --- III. Applicant to sign and date Whenever possible, the initial application will b~ usee , a worksheet only. Where possible. Building Division S1 f. will prepare a type written copy and return it to the applicant at the time the actual permit is issued for H7s signature. IV. Fees and Charges Plan check fees are due and payable at the time of the application, and no plans will be processed until these fees are paid. All other fees and charges are due and payable when the permit is issued. V. FOR OFFICE USE ONLY . · ,4. I \'_ I . .. Ii CITY OF SPRINGFIELD l City Hall Springfield. Oregan Department of Public Work. OFFICIAL RECEIPT No. B 57205, Date ~cb \ 19~ l Rec'd From ~~~~, A ~ IL)....,. ( Address \tY5 Ui \\rn. !\t-.Q. K :J ( Received For: ( ~~}Mt) \~..CXJ ( I DC*J Vf) \ C \) Q ~C':t \ f\ _oU ( ~ -4{) , ( ( Amount Received &0 .CX-J \'X..- .~;~\~.,.., ....... (. ."t:LTO".TU"...ULL ~'lIIoTt:Il" t:UOI"I, 0" \. ( -!!..-. ( . - Permit Clerk PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: Permit applicant exempt from registration with the Builder's Board because: Additional Project Information: PLANS REVIEWED BY: name signature date ~ " '